Traveler’s diarrhea is the most common illness among international travelers with some ten million cases estimated annually.[1] Up to 55 percent of travelers experience traveler’s diarrhea.[2] Destination plays a pivotal role. The illness usually occurs when people from developed nations travel to developing nations and they are exposed to local microbes in the water and/or food that they are not used to.[3] While traveler’s diarrhea is rarely life threatening (and usually self-limiting), it can still hamper your vacation itinerary. Preventive measures are your best bet in avoiding traveler’s diarrhea.

Steps

Part 1

Preventing Traveler’s Diarrhea

1

Do not drink water that hasn’t been sterilized. Tap water and well water aren’t treated in developing nations the same way they are in developed nations. This means that diarrhea-causing microbes are often present. Stick to bottled water rather than water from a tap or well whenever possible.[4]

If you must drink water from a tap, then you should sterilize the water by boiling it for at least three minutes (five minutes if using it to mix baby formula).[5][6] You can also use iodine tablets to sterilize drinking water or a device with a micro-strainer filter, both of which are available at camping stores.[7]

This means you must also avoid ice cubes in beverages since they’re typically made from tap water.[8] (This includes blended drinks, which are blended with ice).

This also means steps you might not consider, including keeping your mouth closed in the shower and using bottled or sterilized water on your toothbrush.[9]

2

Check the seal on beverages. Any beverage on which you break the seal—water, soft drinks, juices, beer, wine, etc. are safe to drink.[10] Ensure you break the seal on these, especially juices to ensure they’re not being mixed from concentrate using local tap water.

When it comes to hot beverages that you can’t bottle such as coffee and tea, ensure that they’re served to you piping hot, which will mean that they’re sterilized.[11]

For milk, cream, etc. ensure that it has been pasteurized.[12] However, even this isn’t a guarantee. You may choose to use non-dairy creamer during your travels.

3

Avoid food from street vendors. Food from street vendors, especially items that require lots of handling and little cooking, are responsible for many cases of traveler’s diarrhea.[13] While you likely want to experience the local cuisine on your travels, you should avoid it from street vendors.

4

Peel your own fruit and vegetables. You should avoid raw fruits and vegetables unless you rinse and peel them yourself.[14] Ensure that you rinse these items in sterilized water. Request to peel the items yourself whenever possible to make sure the peeled items aren’t handled or rinsed with tap water.[15]

5

Eat well-cooked foods. Shellfish, rare meats, and raw items such as salads are prime vectors for the microbes that can cause traveler’s diarrhea.[16] Avoid shellfish and raw dishes, and always order items well done since heat kills bacteria.[17]

Be cautious around foods that are cooked but then sit around as well, such as with buffets.[18]

6

Examine your utensils. You should be extra careful when using the utensils in restaurants.[19] Examine them to ensure that they’re clean before using them. Whenever possible, drink beverages directly from the bottle rather than using a cup or glass.

7

Wash your hands regularly. Washing your hands is always a great step for avoiding germs.[20] If you’re traveling with children, have them avoid touching dirty items and then putting their fingers in their mouths.[21]

You should additionally keep a hand-sanitizing solution that is at least 60 percent alcohol on hand for situations when you can’t wash your hands.[22]

8

Avoid swimming in potentially contaminated water. As with other sources of water, you should be cautious around swimming pools, ponds, etc.[23] Ensure that any swimming pool has been treated with chlorine, and don’t open your mouth in the water.

9

Take caution with spicy food. Some people will get traveler's diarrhea not from contamination, but from unusual and/or excessively spicy foods. This is not what doctors would consider traveler's diarrhea, but if you really want to avoid diarrhea in general, stick with fairly tame foods.

10

Take bismuth subsalicylate. Bismuth subsalicylate (Pepto-Bismol) is a preemptive step that you can also take against developing traveler’s diarrhea. It may prove unnecessary, but it will fight diarrhea before it becomes a problem. Most short-term side effects are harmless (black coloration to your tongue and darkened stool).[24] However, you should not take the medicine for more than three weeks.[25]

Part 2

Treating Traveler’s Diarrhea

1

Stay hydrated. If you unfortunately come down with a case of traveler’s diarrhea, staying hydrated is the most important step. You need to counteract the water and electrolytes lost to the diarrhea (or vomiting in extreme cases). Try to drink eight to ten glasses of water a day from safe or sterilized sources.[26]

Try to drink at least one cup of water for every attack of diarrhea you have.[27]

In moderate to severe cases, you will also want to drink an oral rehydration solution (ORS).[28] These solutions contain the exact combination of clean water, electrolytes, and carbohydrates your body needs to stay hydrated. Follow the directions according to the ORS you buy and drink after each episode of diarrhea. You’ll know you’re staying hydrated if your urine maintains a pale color.[29]

2

Eat smaller meals. Eating smaller meals more frequently is a better way to ensure proper nutrition than three big meals a day while you have traveler’s diarrhea.[30] The smaller portions are also less likely to upset your stomach.

Including salty items such as well-cooked soups and sealed sports drinks will also help you replace electrolytes lost to the episodes of diarrhea.[31]

3

Eat foods rich in potassium. Excess potassium loss is another concern in addition to dehydration when suffering a bout of traveler’s diarrhea. You should add some potassium-rich options to replace the lost mineral, such as bananas (remember to peel them yourself), bottled fruit juices, and well-cooked potatoes.[32]

4

Avoid anti-motility agents. Anti-motility agents (loperamide, diphenoxylate, and paregoric) are available over the counter to treat diarrhea. However, you should avoid these options, especially if your symptoms include fever or bloody stool, because they slow the transit time of matter through your digestive tract. In the case of traveler’s diarrhea, this means that the microbes causing the symptoms remain in your body longer than necessary.

5

Take bismuth subsalicylate. You can take bismuth subsalicylate (Pepto-Bismol) to treat traveler’s diarrhea in addition to as a preventative measure.Follow the manufacturer’s dosage suggestions for two days. If symptoms worsen or do not improve, then see a doctor to rule out the possibility of a parasite.

6

See a doctor. Though unnecessary in the vast majority of traveler’s diarrhea cases, there are some instances for which you should see a doctor. In these cases, the doctor will typically prescribe a short course of antibiotics lasting three to five days. Find a physician if your symptoms worsen to include:

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Tips

You might want to bring a few canned food options with you if you’re traveling to smaller villages. This will ensure you still have food available when the local options all have an increased risk of illness.

If you're on a plane, don't eat large meals.

Remember that traveler’s diarrhea is unpleasant, but it’s self-limiting. Don’t allow worrying about an upset stomach to ruin your travels.

You can tie an object (such as a ribbon) around the faucet in your hotel room to remind you not to drink the tap water or use it on your toothbrush.[33]

Warnings

Food poisoning can be life threatening. Seek medical attention for serious diarrhea, especially if there is blood in it.

If you develop symptoms after your travels, see your doctor and inform him or her of your recent destination. Your symptoms may indicate a parasite from the region with an incubation period.

Very young children in particular are unable to regulate their electrolyte loss properly and therefore extra caution needs to be taken with young children

Reserve iodine tablets rather than using them on everything. Too much iodine can be harmful to your system.[34]